This thread reminds me: whatever happened to Doowai?
I saw he wrote in other thread that he will be starting residency again soon.
This thread reminds me: whatever happened to Doowai?
Hey everyone,
I managed to do two weeks of an anesthesia rotation at my institution. I realized that clinical medicine and the thought process it entails better suits my skill set. Now, I suppose someone else could answer this question- when it comes to LORS, would I want them all to come from my previous attempt at pathology, or a combination from med school and my program. Would it be a worthwhile endeavor to obtain one from my PD despite that the fact that a strong one cannot be written in my favor? I did address the issue in my personal statement about why I would want to change fields- stating desire to interact with patients, more involvment with management, ect. In addition, I realized that being in a tertiary care center was not the most beneficial environment for me personally, as most of my successfull rotations in med school were completed at medium sized institutions.
I had the GME director at my institution review my PS and application and believes that it is good, considering the circumstances. In addition, I will have a few other physicians review it. In addition, I will be talking to a physician in an academic center to discuss my situation and ask for advice.
I am working on resolving my "issues", as I believe that they played a role in my demise the first time around. I realize that had I dealt with these earlier, it is likely that none of this would have occured.
Now, I guess my questions are, what other sorts of documentation should I get from my first program? And what typically would transpire between two PDs when they talk to each other?
Honestly, i would be interested in a list as well...thanks.
The fact that this thread has tens of thousands of views just goes to show how much of a problem this is. As a frequent visitor to this forum, I am quite frankly nauseated to see over and over again new threads spring up by former residents who were just booted out of their program, have been put on probation, are afraid of pending probation, or dropped out altogether because of the hell they have been put through with their programs. In any other job if you get fired you can simply get back up on your feet and just work somewhere else. However, this is not the case with residency. It is like being dropped in the middle of Death Valley in the middle of July and left to fend for yourself without any food or water. As has been discussed before on this forum an MD without residency nearly equals a BA degree. Furthermore, you have all the years you already invested into medical school and the six figure debt that does not go away. This is why this is such a scary scenario and sadly it happens way more than it should. By the way, to the guy above who says more people should get booted from programs- please do all future residents a favor and stay out of academic medicine.
Yes, and another thing is that when you go to interview for med school and/or residency, it's really important to listen to your gut r.e. where you'll "fit" and not feel pressured to try to attend what someone else says is the "best" program. Sometimes you can still make a wrong choice, but in general I've found my gut feelings to be pretty accurate, and when I disregarded them I ended up unhappy and when I listened to them I ended up in better work or school situations. Just my opinion. It doesn't really help people who are already in the crappy/bad position.
I pretty much agree with this, particularly the part I have bolded.
I personally know someone who was fired from a residency, and he then came to our residency and was one of the very best residents there, and had crazy board scores...and I DO mean crazy, and was clinically good as well. The person was supposedly fired for having bad clinical skills, but I've worked with this person and to put it simply, there's no freakin' way that was the case.
I think a lot of the firings happen because of personality conflicts between the resident and attending(s) and/or other hospital staff. I'm not saying that the fired residents are necessarily blameless in these situations, but I'm sure we can all think of situations where someone didn't succeed in a certain work environment/workplace but then did brialliantly somewhere else. In medicine, it seems like if you end up at the wrong program, or just get off on the wrong foot with the PD or even one powerful attending, or perhaps just in the wrong specialty or one that isn't optimal for you, then you can pretty much just lose everything you have worked for for 8+ years of your life. And then there is the financial side of things that Medicinesux has just mentioned. I don't know what the solution is but there are just some huge power inbalances in these types of situations that make it really, really, really difficult for the resident's side of things to get a fair hearing, IMHO.
I admittedly have not read every post within this thread. However, must agree some folks should be terminated. I think it is far more cruel to drag someone along and then terminate after 2 or 3 years. It is unethical to continue someone and graduate them when they are not competently trained. There is absolutely no room in medical training/residency for "social promotion". There are unfair terminations...YES. But, if you look at the post above and in particular, the highlighted portions, the poster fully admits to all the deficiencies listed in the evals he/she was provided. Furthermore, it would appear at best he/she could only hope for being given a "do over" year!!! It may seem socially "fair" to give you a repeat year. However, as an administrator, it is stupid. That is an enormous amount of funding to remediate a resident at the expense of potentially new categorical applicants from the upcoming medical class. Receiving the generous opportunity to repeat a year may be good for the individual but it is not necessarily good for the program or the patients....I am Caribbean grad recently terminated two weeks ago before completing my PGY-1 year in IM.
In January ...program director... ...concerned that ...my clinical judgement poor. He felt that I was not ready to progress to my PGY-2 year and wanted me to repeat my PGY-1 year. ...I agreed that I had these deficiencies and thought repeating the year would be beneficial...
In February, I met with the chief of medicine/interm program director and he handed me a letter listing my deficiencies. The letter ended with a statement stating that if I failed to correct these deficiencies, I would be terminated from the program...
...I was making the appropriate corrections. ...I knew that I still had alot to improve...
Finaly two weeks ago, ...the letter of termination. ...he mentioned that the faculty felt my clinical judgement was poor and that I was not working efficiently...
...I guess I had a sense this was coming. When I first met the interm program director in Febrary and got the probation letter, the letter mentioned so many deficiencies...
I do not deny that I have the deficiencies mentioned and I do agree that repeating my PGY-1 year would be good for me. I just don't understand what my attendings saw in me that made them feel I should be terminated......I think we fail fewer residents than we should rather than the opposite.
The number of visits to this thread or any other does not equate any amount of "evidence" or "proof". At the very least, in reference to the post I noted above, the individual fully admits to such a level of deficiency that starting over was warranted. If someone is not even performing up to par at the level of a PGY1, it is potentially unsafe for them to remain. No PD or hospital should wait for a patient injury to make this decision. The poster him/herself readily admits to this level of deficiency. It would be nice to be given the gift of a re-do. But, just because you have spent money to get to the point you are, it does not mean you are qualified for your position or that you have received an adequate education to provide care as a physician. The true injustice is to graduate someone from a medical school foreign or domestic when that individual is not qualified. There are too many folks moving forward/up in a system of inflated grades and too many unqualified folks walking around with diplomas...The fact that this thread has tens of thousands of views just goes to show how much of a problem this is. As a frequent visitor to this forum, I am quite frankly nauseated to see over and over again new threads spring up by former residents who were just booted out of their program, have been put on probation, are afraid of pending probation, or dropped out altogether because of the hell they have been put through with their programs...I pretty much agree with this...
I think a lot of the firings happen because of personality conflicts between the resident and attending(s) and/or other hospital staff. I'm not saying that the fired residents are necessarily blameless in these situations, but I'm sure we can all think of situations where someone didn't succeed in a certain work environment/workplace but then did brialliantly somewhere else. ...I don't know what the solution is but there are just some huge power inbalances in these types of situations that make it really, really, really difficult for the resident's side of things to get a fair hearing, IMHO.
As a potential med student, this thread makes me sad.
Why does it seem everything in medicine isn't as good as one is led to believe as a premed.
Sigh.
This is a surprising trend that I hear often..... Please, if I can convince medical students and residents of only one thing, it is that "objective" examinations, even if you don't like them do matter. It is said too often that "being a team player, being a hard worker, and/or being a "nice guy" is more important then the in-service exam...". Do NOT believe it; Buyer beware!!!...poor inservice exam scores. ...we were told that the grades mean NOTHING...
The fact that this thread has tens of thousands of views just goes to show how much of a problem this is. As a frequent visitor to this forum, I am quite frankly nauseated to see over and over again new threads spring up by former residents who were just booted out of their program, have been put on probation, are afraid of pending probation, or dropped out altogether because of the hell they have been put through with their programs. In any other job if you get fired you can simply get back up on your feet and just work somewhere else. However, this is not the case with residency. It is like being dropped in the middle of Death Valley in the middle of July and left to fend for yourself without any food or water. As has been discussed before on this forum an MD without residency nearly equals a BA degree. Furthermore, you have all the years you already invested into medical school and the six figure debt that does not go away. This is why this is such a scary scenario and sadly it happens way more than it should. By the way, to the guy above who says more people should get booted from programs- please do all future residents a favor and stay out of academic medicine.
This is a surprising trend that I hear often..... Please, if I can convince medical students and residents of only one thing, it is that "objective" examinations, even if you don't like them do matter. It is said too often that "being a team player, being a hard worker, and/or being a "nice guy" is more important then the in-service exam...". Do NOT believe it; Buyer beware!!!
As a medical trainee, you are there first and foremost to be trained in both the technical AND cognitive components of your given specialty/discipline. As a trainee, putting the patient as first priority, by definition, MANDATES that you read and study so you are as clinically competent as possible.... it does not mean sitting at the patients bedside holding their hand. In the end, "nice guy" on a "subjective" evaluation form from an attending that you did not wake-up at 2am does NOT overcome a black and white numeric value on the in-service exam. My local grocer is a "nice guy" but that does not mean I want him taking care of my grandma during an emergency.
We can argue the validity of in-service exams all day long. However, there are surveys and studies suggesting a minimum performance on these exams translates to ability to achieve board certification (i.e. ???minimum fund of knowledge and clinical judgement).... "nice guy" translating to successful board certification has NOT been demonstrated. Residency is a package deal. I can not speak for any other specialties' in-service examination other then surgery. And, for surgery, I have to tell you that is a VERY, VERY studiable exam. With the exception of the exceedingly rare minority, all residents are adults. Get your old questions and study. Get your review books and study. The score on that exam can be your shield or it can be your PD's axe. The choice is yours.
EXACTLY!!! I never understood how presumably smart people, presumably the upper end of intelligence and education, presumably folks that have spent years and years developing study habits and test taking skills.... suddenly get into residency and become "dumb". Your need to study does NOT end when you start residency. At the very least it INCREASES. You are now a physician. Your patient's lives now depend on you having read and having the right answers....With the exception of the exceedingly rare minority, all residents are adults. ...The score on that exam [in-service]can be your shield or it can be your PD's axe. The choice is yours....more than anything am annoyed at myself for not taking this more seriously. I've never done badly on an exam, in medical school or college, I should have realized residency would be no different. ...all I can say is DUH!...
EXACTLY!!! I never understood how presumably smart people, presumably the upper end of intelligence and education, presumably folks that have spent years and years developing study habits and test taking skills.... suddenly get into residency and become "dumb". Your need to study does NOT end when you start residency. At the very least it INCREASES. You are now a physician. Your patient's lives now depend on you having read and having the right answers.
The level of responsibility changes exponentially when you go from medical student to MD/DO. That exponential change continues when you go from trainee license to "unrestricted" license. It further continues when you go from trainee/rsident to ATTENDING. Do NOT fall for the trap or take the bait of... "being a nice guy/gal" is what is most important.
You need to be a good doctor first.... yes, bedside manner is important, but a "nice guy/gal" at bedside that doesn't know what they should is dangerous.... especially since they might get more patients referred because they are "nice" even as they are incompetent.
Please, please, please..... continue to study. It is the right thing to do for you and most importantly your patient/s.
JAD
PS: have some pride too. I don't understand how someone that maintained 4.0 status in undergrad, went AOA in med-school, etc would accept below average test performance in residency. It should be very, very embarassing.
Memories are quite short..... remember that little series of examinations under the heading of USMLE? Those too are really suppose to be meant as a "pass/fail" assessment. They are/were not intended to be used as a "ranking tool".... You take that test and a score results next to your name....was told that the in training exam score ......The ABIM also says that the test is primarily for identification of deficiencies so the resident knows what to study and isn't supposed to be used to "rank" residents per se....more passive aggressive and they claim the test isn't to be used to rank people and then they do just that. So beware...
You need to decide if that score is respectable or not. Or, you can take a path of rationalizing low scores or pushing the belief in a lack of importance of those scores if that makes you happier....The score on that exam can be your shield or it can be your PD's axe. The choice is yours...
So be it... I suspect, if a PD is worth any credibility, how well or how poor will effect the quality of a letter he/she may write on your behalf without even putting the score. Also, phone calls are made and "unofficial" comments will occur. What you may believe is a strong letter may in the world of PDs and Fellowship directors actually be "code" for OK, but not my greates hope for the future... PDs have become very atune to how to phrase things in order to send a message without outright stating the obvious....USMLE scores are specifically released to residency programs ...The internal medicine ITE is specifically NOT allowed to be released ...no fellowship program asked for a copy of my ITE exam scores, and the PD was not allowed to give these out...
UPDATE from Aucdiver:It IS stupid, aucdiver. I hope you get one of those jobs.
1. Yes, but it's completely ethical to dump someone on their ass after:I admittedly have not read every post within this thread. However, must agree some folks should be terminated. I think it is far more cruel to drag someone along and then terminate after 2 or 3 years. It is unethical to continue someone and graduate them when they are not competently trained. There is absolutely no room in medical training/residency for "social promotion". There are unfair terminations...YES. But, if you look at the post above and in particular, the highlighted portions, the poster fully admits to all the deficiencies listed in the evals he/she was provided. Furthermore, it would appear at best he/she could only hope for being given a "do over" year!!! It may seem socially "fair" to give you a repeat year. However, as an administrator, it is stupid. That is an enormous amount of funding to remediate a resident at the expense of potentially new categorical applicants from the upcoming medical class. Receiving the generous opportunity to repeat a year may be good for the individual but it is not necessarily good for the program or the patients.
After that meeting, I worked as hard as I could. Asking attendings if they saw any deficiencies and making any necessary changes. I tried working faster and read more. I spoke to my residents to see if I could make any changes.
C. They were told they have a job, but not necessarily a promotion to PGY2:So I continued to work harder, coming in early and trying to get feedback from residents and attendings. I attempted to make as many corrections to deficiencies that I could.
He also mentioned that I would be continued to be monitored by the faculty and depending on their recommendation I would be promoted or not.
The fact that this thread has tens of thousands of views just goes to show how much of a problem this is. As a frequent visitor to this forum, I am quite frankly nauseated to see over and over again new threads spring up by former residents who were just booted out of their program, have been put on probation, are afraid of pending probation, or dropped out altogether because of the hell they have been put through with their programs. In any other job if you get fired you can simply get back up on your feet and just work somewhere else. However, this is not the case with residency. It is like being dropped in the middle of Death Valley in the middle of July and left to fend for yourself without any food or water. As has been discussed before on this forum an MD without residency nearly equals a BA degree. Furthermore, you have all the years you already invested into medical school and the six figure debt that does not go away. This is why this is such a scary scenario and sadly it happens way more than it should. By the way, to the guy above who says more people should get booted from programs- please do all future residents a favor and stay out of academic medicine.
A Resident who is fired from residency program can apply to state medical board license based on number of years successively completed on training from ACGME approved programs. Some states require only one year, some two and majority three years. The job of the State medical board is to make sure these physicians are safe when dealing with the public, they should not be issued license, if there is any problem beyond reasonable doubt, in the assessment of their respective state medical board. These folks will be unleashed to treat humans fellow Americans.
<snip...a bunch of rambling crap that made no sense>
IMHO there seems to be failure on creating true checks and balance system in the United States GME, and there seem to be health business factor as well as many human factors including doctor persona and egotism that result in wasteful resources. I hope the current financial crises and health care reform will address these issues more closely.
What? It's a little early to be that drunk don't you think?
A Resident who is fired from residency program can apply to state medical board license based on number of years successively completed on training from ACGME approved programs. Some states require only one year, some two and majority three years.
The job of the State medical board is to make sure these physicians are safe when dealing with the public, they should not be issued license, if there is any problem beyond reasonable doubt, in the assessment of their respective state medical board. These folks will be unleashed to treat humans fellow Americans.
From market point of view, most hiring vendors require BE/BC for malpractice insurance, hospital privileges, etc. so the fired resident, still with a license, will have great difficulty finding a job compared to those with BE/BC.
There is some good reason(s) why a resident will be fired, at least from PD point of view, and most program directors carry responsibility of protecting the public as well, and weed out those who may provide risky practices.
At the end of the day they will find some way to treat patients and make living for themselves and families.
The question is there any discrepancy between the state medical board assessment and residency program directors?
If these physicians will treat humans regardless, and the residency program directors opinion is valued, is there any moral obligation to provide tools, career counseling and modification to accommodate these physicians for public safety and government money spend wisely.
Does the residency programs, including PDs, make the conscious decision and selection to hire these residents but seems not good enough judgment vis-a-vis firing them at the end.
What is moral obligation for these residency programs in facing this public problem that seems to be increasing?
Some may argue this resident need to be fired, even the reasons does not qualify the criteria of state medical board (e.g) unprofessional conduct based on learning disability, etc.
IMHO there seems to be failure on creating true checks and balance system in the United States GME, and there seem to be health business factor as well as many human factors including doctor persona and egotism that result in wasteful resources. I hope the current financial crises and health care reform will address these issues more closely.
What? It's a little early to be that drunk don't you think?
I think termination shouldn't be allowed in residency, due to the capped funding. where is a resident going to go if they can't ever get back in again because they used up their funding?
if there is to be termination, then there shouldn't be any capped funding, we should be free to go to whatever program we please, without funding issues. However, until then, termination shouldn't be an option. it is too unfair. and many get terminated per year, so this shows many residents are screwed out of becoming a doctor due to this capped funding.
First of all, no resident is lazy or incompetent. If you have the drive and initiative to get into med school, get through med school, and get into residency -- you already put in so much effort, time, and money into the whole process that you are clearly motivated, was cleared on the competence issue by med school/exams, etc.
Second of all, I would like to share my sad story of woe. First residency I matched into was General Surgery. Full of piss and vinegar, ready to do whoever and whatever -- I lasted only a month in it and had to quit b/c of it being too overwhelming and just not being able to handle it. Discussed the difficulty before quitting with PD and Graduate Studies Director, but was given no guidance or help.
Miraculously matched into a less intense residency of Family Medicine -- anything just to keep the career. Was dimissed from that residency in three months after I missed a day of work due to hospitalization. Was honest and stupid enough to tell the PD that I was hospitalized for phsychiatric reasons (resolved once I cought up on my sleep). Was not allowed to come back, was told to seek therapy, then to call back and see.
a) how could I afford therapy if you just fired me and I have to move in back with my parents/parent?
b) i missed a day of work due to hospitalization -- b/c of HIPAA it is none of your business why I was hospitalized, for all you know, I had gastroenteritis and had to spend a day at the ER.
c) if you really want to help me and have me be part of your residency, why don't you keep me as a resident and arrange me to have one half-day off/wk to go see your in-house or private physician, thus making sure I get the help you require of me (and I supposedly need), but at the same time not leaving me without a means to support myself.
d) The program director left the residency six months after I got fired/dismissed. So in 12 months, when I was ready to work and called back to see if they would take me back -- there was a new program director and no one knew who I was and what I was talking about.
e) All my issues were cured by getting enough sleep, not meds, not therapy, just good old restorative, REM sleep and rest.
f) I find it impossible to get a job anywhere except places that pay minimum wage. And I have med shcool debt. My career which was the basket into which I put in all my eggs has been destroyed. The loss one experience when being dismissed from such a prestigious position as a resident/physician is devastating and beyond anything I can say in words to describe the feeling.
g) I find it impossible to get new letter of recommendation from anywhere to apply again.
h) finally, I was dimissed for phsychiatric issues, but I had none or did have them but they were under control. however, after it sank in and I realized that there was no way for me to ever become a physician and that I would have start over -- that's when psychiatric issues of grief and loss and all that that entails surfaced.
The dismissal from residency makes me regret my decision to go into medical school and many other choices I made. There was a point after I was dimissed from residency when I realized if I lose my own kid one day, I would not probably grieve as badly as I did regarding the loss of my career -- now of course I don't think so and realize there are worse things than losing a job/career, but still .....
First of all, no resident is lazy or incompetent. If you have the drive and initiative to get into med school, get through med school, and get into residency -- you already put in so much effort, time, and money into the whole process that you are clearly motivated, was cleared on the competence issue by med school/exams, etc.